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July 2008
Volume 1 | Issue 7
Page Nos. 94-109
Online since Friday, September 5, 2008
Accessed 4,873 times.
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| MEDICOLEGAL REPORT |
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Synchronizing time in all watches used in a hospital/nursing home |
p. 94 |
- All the watches that are used for recording time in a hospital/nursing home (wrist, table or wall) must be synchronized, i.e., they must have the same time. Moreover, medical, para-medical, and nursing staff must be duly instructed to note and record the time from only such watches, which are synchronized.
- Maintain discipline in recording exact time except in cases of emergencies.
- After completing delivery/procedure/surgery, sit for at least a minute and carefully see if everything has been recorded properly. Medical records have the greatest evidentiary value and work both ways - for and against a doctor. In addition, remember that ultimately the primary liability rests on a doctor's shoulder, although it is usually the para-medics and nurses who prepare medical records.
- Entries in medical records must be made serially. Entries made in margins or overwriting must be avoided. At times they lead to an inference that the records have been manipulated.
- Preserve medical records pertaining to indoor patients for a period of 3 years from the date of commencement of the treatment.
- Hospitals/nursing homes having maternity wards must ensure that separate files/folders or at least separate sheets are used for both the infant and the mother. Avoid using the same sheet/file/folder for both infant and mother.
- Avoid the practice of recording abnormal findings only. Vitals even if they are normal must be recorded accurately and regularly.
- In delivery patients, presence of a qualified gynecologist is mandatory, except in cases of unforeseen emergencies. If the gynecologist under whose care the patient is admitted is unable to attend at least another duly qualified gynecologist must be present during delivery.
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Acceptance of unknown/unexplained complications by law |
p. 96 |
- In case an unknown/unexplained complication arises, during or after the treatment, record the symptoms and diagnosis, if any, in the case papers.
- Remember that every complication or reaction cannot be explained and the law accepts this limitation of modern medicine. In the instant case, the court accepted that the exact cause of multiple sclerosis is not known.
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Consent of patients relatives/friends/attendants for conducting post-mortem |
p. 98 |
- No consent of patients relatives/friends/attendants is required for conducting a post-mortem in case of any unnatural death. There may be request or at times even pressure, not to inform the police but heeding to any such request would amount to patent illegality. In case of any unnatural death the onus to inform the police lies on the doctor/hospital/nursing home.
- Inform the police in writing of the death and preserve a copy thereof bearing their acknowledgment. Specifically request for a post-mortem even though the duty to send the dead body for post-mortem lies with the police.
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Performing a non-emergency procedure/surgery - unannounced, unscheduled |
p. 99 |
- It is unadvisable to conduct a non-emergency procedure/surgery unannounced. Announce date and time of procedure/surgery well in advance and duly record the same in both the medical records and consent form. Try to perform the procedure/surgery on schedule.
- Extra care must be taken in case of diabetic IPD patients. Blood sugar must be regularly monitored and duly recorded. Dose and time of administering insulin must also be carefully recorded.
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Chances of misdiagnosis in a 'known' patient presenting with the usual symptoms |
p. 100 |
- Care must be taken in treating a patient who comes with one type of symptoms as the natural tendency is to make diagnosis for that disease. Necessary investigations must be done if some abnormality is found or the patient does not respond to the usual line of treatment.
- Commercial hospitals/nursing homes who may at times treat patients without fees must insist that the patient gives a written request for free treatment. This request letter must be carefully preserved in medical records of the patient.
- Before zeroing on the diagnosis, conducting the requisite tests is mandatory.
- Referral note must contain all the necessary details of case history, symptoms, diagnosis, investigations, and treatment.
- Do not give original medical records of the patient to anyone, especially in case of known or familiar patients. Medical records are the property of the doctor.
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Ideal time for giving/starting certain medications/surgeries/procedures |
p. 102 |
- When a procedure or medicine is not given/started at the ideal or indicated time, reasons thereof must be duly recorded. (In the instant case, as the patient was at high risk, ideally syntocinon drip ought to have been started in the morning, but was started in the evening without any justification.)
- High-risk patients need close and continuous monitoring and vitals must be recorded at recommended intervals.
- Discontinuation of any medication warrants special attention and proper justification.
- Specifically record if there has been any delay in reporting by the patient.
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What to do with a serious patient and no vacant bed in ward/ICU |
p. 104 |
- In case all the beds/wards/ICU (wherever required) in the hospital/nursing home are fully occupied and a patient under treatment requires urgent admission or transfer to ICU, efforts must be made to get the patient admitted in another hospital/nursing home in the vicinity having the requisite facilities.
- Discharge Card/ticket must briefly record history, diagnosis, treatment, and further advice.
- Reports of investigation and X-ray/MRI/CT Scan must not only be preserved, but the findings must also be recorded in the case papers of the patient.
- In case any incident or accident has prevented/delayed you from attending to a patient, it is advisable to record the same in the patient's medical records.
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Proper and accurate record of clinical history - A tool in doctor's legal defense |
p. 106 |
- Take complete and accurate history of a patient. At times, it proves as a good tool for self-defense in a court. In the instant case, the court was influenced by the fact that the patient was a "heavy smoker and alcoholic" (in fact, this quote finds a place in the opening sentence of the Court's findings).
- Keep yourself updated on the present practice worldwide, especially in areas of your specialization.
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Investigation reports - Accuracy, disclaimer, and indemnity |
p. 107 |
While reporting on any investigations, it is advisable to specifically state the accuracy of the procedure undertaken. In case of sensitive or new techniques/procedures, such as investigations to detect congenital abnormality in a fetus, the aforesaid disclaimer must be very prominent. It would also be advisable to insert a suitable indemnity clause in all such investigation reports. |
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Request of hospitalized patient for opinion/visit/consultation by another doctor |
p. 108 |
- Request of IPD patients for opinion/visit/consultation by another doctor must not be refused in the normal course.
- In risky and complicated procedures, advice proper and necessary investigations - that too in time.
- Shifting the patient from normal bed/ward to ICU or ICCU and vice-versa must solely be in the patient's interest.
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